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Important coronavirus update sent to ophthalmologists

RANZCO will be forwarding to its members the latest coronavirus alert from the American Academy of Ophthalmology (AAO), providing updated information after two studies further established a link between the virus and conjunctivitis.

In its latest post titled: Alert: Important coronavirus updates for ophthalmologists, the AAO shared ophthalmology-specific information for the novel coronavirus, including possible methods of transmission and protection measures with the use of disinfectants and slit lamp shields.

It referred to the virus as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known by the provisional name 2019-nCoV. The highly contagious virus can cause a severe respiratory disease known as COVID-19.

Specifically, the AAO reiterated reports that have identified an association between the virus and conjunctivitis. RANZCO CEO Dr David Andrews said the college would pass on the AAO alert today, as well as regular updates from the respective Australian and New Zealand departments of health, to fellows, trainees and associates.

The AAO highlighted two recent cases that suggested the virus can cause conjunctivitis, meaning it is possible that SARS-CoV-2 is transmitted by aerosol contact with the conjunctiva.

In a Journal of Medical Virology study of 30 patients hospitalised for COVID-19 in China, the AAO said one had conjunctivitis. That patient – and not the other 29 – had SARS-CoV-2 in their ocular secretions.

“This suggests that SARS-CoV-2 can infect the conjunctiva and cause conjunctivitis, and virus particles are present in ocular secretions,” the AAO said.

In a larger study published in the New England Journal of Medicine, researchers also documented “conjunctival congestion” in nine of 1,099 patients (0.8%) with laboratory-confirmed COVID-19 from 30 hospitals across China.

“While it appears conjunctivitis is an uncommon event as it relates to COVID-19, other forms of conjunctivitis are common,” the AAO said.

“Affected patients frequently present to eye clinics or emergency departments. That increases the likelihood ophthalmologists may be the first providers to evaluate patients possibly infected with COVID-19.”

The AAO recommended eyecare professionals protect their mouth and nose with a face mask, such as an N-95 mask, and eyes with goggles or a shield when caring for patients potentially infected with COVID-19. In addition, slit-lamp breath shields were also considered helpful for protecting both healthcare workers and patients from respiratory illness.

Key information

The AAO warns that patients who present to ophthalmologists for conjunctivitis who also have fever and respiratory symptoms including cough and shortness of breath, and who have recently travelled internationally, particularly to areas with known outbreaks – China, Iran, Italy, Japan, and South Korea – or with family members recently back from one of these countries, could represent cases of COVID-19.

The virus that causes COVID-19 is also said to be “very likely susceptible” to the same alcohol and bleach-based disinfectants that ophthalmologists commonly use to disinfect instruments and office furniture.

To prevent SARS-CoV-2 transmission, the academy stated the same disinfection practices already used to prevent office-based spread of other viral pathogens are recommended before and after every patient encounter.

The virus is believed to spread primarily via person-to-person through respiratory droplets produced when an infected person coughs or sneezes. It also could be spread if people touch an object or surface with virus present from an infected person, and then touch their mouth, nose or eyes. Viral RNA has also been found in stool samples from infected patients, raising the possibility of transmission through the faecal/oral route.

Currently, US federal officials are trying to determine if there is asymptomatic transmission.

Questions to identify patients exposure to SARS-CoV-2

  • Does the patient have respiratory symptoms?
  • Has the patient recently travelled internationally?
  • Does the patient’s international travel include a recent trip to Iran, Italy, Japan and South Korea, or do they have family members recently back from one of these countries?

Recommended protocols when scheduling or seeing patients

  • When phoning about visit reminders, ask to reschedule appointments for patients with non-urgent ophthalmic problems who have a respiratory illness, fever or returned from a high-risk area within the past two weeks.
  • Patients who come to an appointment should be asked before entering the waiting room about respiratory illness and if they or a family member have travelled to a high-risk area in the past 14 days. If they answer yes to either question, they should be sent home and told to speak to their primary care physician.
  • Sick patients who possibly have COVID-19 with an urgent eye condition can be seen, but personal protective equipment should be worn by all who come in contact with the patient. Recommendations for personal protective equipment include gloves, gowns, respiratory protection and eye protection. Place a facemask on the patient and isolate them in an examination room with the door closed; use airborne infection isolation rooms (AIIR) if available. Rooms should be thoroughly disinfected afterward.



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